Matt Morgan: Covid-19 and the need for bold decisionsBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2320 (Published 16 June 2020) Cite this as: BMJ 2020;369:m2320
- Matt Morgan, intensive care consultant
Follow Matt on Twitter: @dr_mattmorgan
Covid-19 has highlighted the complicated decision making that leads to public health policies. At the start of the pandemic the decisions playing out on endless news reports were about ventilators and personal protective equipment (PPE). Now they’re about testing and contact tracing, how to ease the lockdown, and how to open shops and schools.
People imagine that the toughest decisions I make at the coalface of medicine, in the intensive care unit, are similar. What drugs should we use? What knobs should we turn on our ventilators? Yet the reality is rather dull. The toughest decisions that the covid-19 crisis brings are much more mundane—but much more important.
These are decisions such as: how can we accurately keep track of hundreds of new patients? How can we disseminate complex information to large teams of people that change every 12 hours? How can we talk on phones while masks cover our faces and no one remembers the phone numbers? How can we quickly train hundreds of dental hygienists to care for critically ill patients?
It’s these decisions about communications, logistics, training, and workforce that give us sleepless nights, not the medical ones. Medicine is what I do. It’s what I know. I feel it, I live it, and I feel at home within it. I’m happy surrounded by complex machines, monitoring blood pressures and brainwaves. But when we have to decide which walkie talkie to use to speak to an isolated ward nurse—that’s when the real stress sets in.
What we need in these days of decisions, more than ever, is PPE: not more sweaty masks or 3D printed steamy visors but People, Professionals, and Experts. I shouldn’t be deciding on what walkie talkie to buy after my night shift, just as I wouldn’t call the hospital switchboard to come and do CPR. The challenges that healthcare systems now face should be tackled by experts in industries suited to solving them. Don’t ask the ward receptionist to help track hundreds of patients—let’s ask the air traffic controllers at Heathrow. Deans of medicine are amazing at educating medical students over five expensive university years, but McDonald’s will blow them out of the water when delivering structured, consistent, focused training to hundreds of new staff.
So, while the government has focused on procurement of goods, we need to procure better systems of thought. This is what the NHS was originally built on. Nye Bevan, standing in the Welsh industrial coal scars of the 1940s, could not have predicted the scope of his promise. When his words “free healthcare for all” were uttered, they meant only a handful of operations and a fistful of drugs. But he wasn’t concerned just with the provision of goods; rather, the provision of experts. Although a global pandemic was probably not at the front of his mind, these founding principles are true today more than ever.
Applying industrial analogies to people requires bold decisions. It’s much easier to show pictures of shiny new ventilators than to admit that we need help with our own thoughts. But bold is what’s needed.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.
Provenance and peer review: Commissioned; not externally peer reviewed.
Matt Morgan, honorary senior research fellow at Cardiff University, consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination.
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